title: CHIVA method for the treatment of chronic venous insufficiency.
abstract: BACKGROUND
  Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system.
  
  
  OBJECTIVE
  To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins.
  
  
  METHODS
  The Trials Search Co-ordinator of the Cochrane Peripheral Vascular Diseases Group searched the Specialised Register (November 2012), CENTRAL (2012, Issue 10) and clinical trials databases. The review authors searched PubMed and EMBASE (December 2012). There was no language restriction. We contacted study authors to obtain more information when necessary.
  
  
  METHODS
  We included randomized controlled trials (RCTs) that compared the CHIVA method versus any other treatments. Two review authors independently selected and evaluated the studies. One review author extracted data and performed the quantitative analysis.
  
  
  METHODS
  Two independent review authors extracted data from the selected papers. We calculated the risk ratio (RR), mean difference (MD), the number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI) using Review Manager 5.
  
  
  RESULTS
  We included four RCTs with 796 participants (70.5% women) from the 434 publications identified by the search strategy. Three RCTs compared the CHIVA method with vein stripping, and one RCT compared the CHIVA method with compression dressings in people with venous ulcers. We judged the methodological quality of the included studies as low to moderate. The overall risk of bias across studies was high because neither participants nor outcome assessors were blinded to the interventions. The primary endpoint, clinical recurrence, pooled between studies over a follow-up of 3 to 10 years, showed more favorable results for the CHIVA method than for vein stripping (721 people; RR 0.63; 95% CI 0.51 to 0.78; I(2) = 0%, NNTB 6; 95% CI 4 to 10) or compression dressings (47 people; RR 0.23; 95% CI 0.06 to 0.96; NNTB 3; 95% CI 2 to 17). Only one study reported data on quality of life and these results presented graphically significantly favored the CHIVA method.The vein stripping group had a higher risk of side effects than the CHIVA group; specifically, the RR for bruising was 0.63 (95% CI 0.53 to 0.76; NNTH 4; 95% CI 3 to 6) and the RR for nerve damage was 0.05 (95% CI 0.01 to 0.38; I(2) = 0%; NNTH 12; 95% CI 9 to 20). There were no statistically significant differences between groups regarding the incidence of limb infection and superficial vein thrombosis.
  
  
  CONCLUSIONS
  The CHIVA method reduces recurrence of varicose veins and produces fewer side effects than vein stripping. However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
authors.affiliation: Angiology, Vascular and Endovascular Surgery, Hospital de la Santa Creu i Sant Pau, IBB Sant Pau, Barcelona, Spain. sbellmunt@santpau.cat.
authors.forename: Sergi
authors.initials: S
authors.lastname: Bellmunt-Montoya
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Escribano
authors.forename: Jaume
authors.initials: J
authors.lastname: Dilme
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Martinez-Zapata
mesh_terms: D002908:Chronic Disease; D058128:Compression Bandages; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012039:Regional Blood Flow / Q000502:physiology; D014647:Varicose Ulcer / Q000209:etiology / Q000601:surgery*; D014689:Venous Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*